Original ArticleDelayed emergence of a parkinsonian disorder or dementia in 81% of older men initially diagnosed with idiopathic rapid eye movement sleep behavior disorder: a 16-year update on a previously reported series
Introduction
In 1996, we reported that 38% of a series of 29 males ⩾50 years old developed a parkinsonian disorder (all presumably with Parkinson’s disease [PD]) at a mean interval of nearly 13 years after the onset of idiopathic rapid eye movement sleep behavior disorder (iRBD) [1]. In that report, 16 patients with persistent iRBD were last evaluated on average six years from the time of their RBD diagnosis. We now provide a 16 year update from our 1996 report, with the primary focus of this report being the percent of iRBD patients who eventually developed parkinsonism/dementia, the interval from onset of iRBD to onset of parkinsonism/dementia, and the post-mortem neuropathological findings in two cases.
Section snippets
Methods
The methods of evaluation and follow-up have previously been described [1]. All patients had video-polysomnography (vPSG) confirmed RBD. Three patients (n = 1 with PD; n = 2 with dementia with Lewy bodies [DLB]), were subsequently referred to the Mayo Clinic to be managed by one of the authors (BFB) after their neurological disorders had emerged. One patient was lost to follow-up, but his wife was eventually contacted, and she provided information about her husband’s dementia, and clinical
Results
80.8% (21/26) of patients initially diagnosed with iRBD eventually developed parkinsonism/dementia. Table 1 contains the list of parkinsonism/dementia diagnoses, and the Fig. 1 provides a distribution of time intervals for conversion from iRBD to parkinsonism/dementia. The two patients with MSA had autonomic failure/urinary dysfunction with parkinsonism. One of these patients had persistent hypotension despite vigorous therapy with pressor agents, with his sitting BP commonly being 100/50, and
Discussion
The main findings from this study of men ⩾50 years, initially diagnosed with iRBD at the Minnesota Regional Sleep Disorders Center, is that the vast majority (80.8%) eventually developed a parkinsonian disorder/dementia, and often with a prolonged interval from onset of RBD to delayed emergence of parkinsonism/dementia, with the mean interval being 14 years and the range extending to 29 years. Also, the specificity of the RBD-parkinsonism/dementia association is striking, as only one patient from
Conflict of Interest
The ICMJE Uniform Disclosure Form for Potential Conflicts of Interest associated with this article can be viewed by clicking on the following link: http://dx.doi.org/10.1016/j.sleep.2012.10.009.
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